Physiotherapy after thumb extensor tendon repair in Verdan zone III. Case study.

BACKGROUND: Finger tendon injuries represent very common consequences of hand injuries and, if not properly treated, can lead to substantial hand function impairment and interfere with activities of daily living. This article presents the results of rehabilitation of a female patient after thumb extensor tendon injury in Verdan's zone III. MATERIAL AND METHODS: Based on standard diagnostic work-up (assessment of the active range of motion), we calculated the degree of functional hand function impairment according to Swanson's method. The diagnostic procedures also comprised measurements of dynamometric grip strength and precise grasp. The examinations were performed on four occasions, the first one during the first visit, and the last one a month after completion of the rehabilitation treatment in our Centre. RESULTS: Test results were used to design the treatment programme, which included among others the author's modification of Kleinert's dynamic reverse thumb splinting, peg-board exercises, physical therapy, individual therapy and home-based exercises. CONCLUSIONS: 1. The modified dynamic splint of our design fulfilled its task as both a preventive and therapeutic measure. 2. The dynamic splinting programme administered enabled early initiation of post-operative rehabilitation, which led to a very high degree of recovery of thumb and hand function. 3. The functional recovery outcomes achieved by our patient indicate the advisability of routine incorporation of full dynamic splinting in post-operative rehabilitation programmes of patients with thumb extensor tendon injuries.

Method and results of rehabilitation for extensor tendon injury of fingers II-V in zone I and II.

BACKGROUND: Extensor tendon injuries in zone I and II are the most common closed tendon injuries. The aim of this study was to present a therapeutic programme and the results of rehabilitation of patients with these injuries relative to patient management following the injury. MATERIAL AND METHODS: The subjects were 50 patients who had sustained injuries to extensor tendons of fingers II-V in Verdan's injury zones I and II. The patients were undergoing treatment in Malopolskie Hand Rehabilitation Centre, L. Rydygier Hospital in Kraków. The evaluation was based on physiotherapeutic diagnostic techniques which included the measurement of the active range of motion, function tests and a two-point discrimination test. Swanson's methodology was used for the assessment of hand function impairment. RESULTS AND CONCLUSIONS: The evaluation results and their analysis revealed a difference in the outcome of rehabilitation relative to patient management following the injury (surgical vs. conservative). The programme of rehabilitation was also shown to be effective.

Restoration of hand function and ability to perform activities of daily living following surgery for carpal tunnel syndrome.

BACKGROUND: The aim of the study was to assess treatment efficacy in patients following surgery for carpal tunnel syndrome and compare hand function with patients' subjective evaluation and their ability to carry out activities of daily living. MATERIAL AND METHODS: The study involved patients undergoing rehabilitation at the Malopolska Region Hand Rehabilitation Centre at L. Rydygier Specialized Hospital in Cracow and at the Hand Rehabilitation Unit at the Scanmed Medical Centre in Cracow. The patients were admitted to the Centre after surgical release of the transverse ligament of the wrist. Fifty hands (40 patients) were evaluated and treated. The rehabilitation programme was customised for each patient, and included patient education, a programme of home-based exercises and physiotherapeutic treatment in our centres. The patients were evaluated twice: before starting rehabilitation and at the end of the treatment. Hand function was evaluated using Swanson's method, the Alderson-McGall Hand Function Questionnaire and the Nine Hole Peg Test. Patients were also asked to provide a subjective evaluation of the typical signs and symptoms of CTS. RESULTS: The study showed improvement in all tests and a high level of correlation between various evaluations of hand function and patients' subjective feelings. CONCLUSIONS: The time at which post-operative rehabilitation was started significantly affected the outcomes of rehabilitation in the study group. There was a significant correlation between hand function impairment and subjective feelings of the patients vs. their quality of daily living.

Regimen and results of physiotherapy in patients following surgical treatment of ulnar nerve injury.

BACKGROUND: Ulnar nerve injuries are the most common cause of damage to the nerves of the hand. Diverse mechanisms of injury may be involved, the most frequent being injuries to various areas within the forearm, usually lacerations. In such cases, surgery followed by physiotherapy is a treatment of choice. The aim of the study was to estimate the efficacy of physical therapy following surgical treatment of ulnar nerve injuries. MATERIAL AND METHOD: The study group initially comprised 33 patients. Twelve patients with additional damage to the median nerve were excluded and further analyses concerned a group of 21 patients with ulnar nerve injuries who underwent physiotherapy at the Malopolska Regional Hand Rehabilitation Centre in Cracow. Treatment outcomes were evaluated on the basis of measurements of hand function including the range of motion, function tests as well as sensation and dynamometric tests. RESULTS AND CONCLUSIONS: Range of motion data were used to assess movement impairment according to Swanson's method. The measurements were taken on two occasions before and after the physiotherapy. Analysis of the results revealed significant efficacy of the physiotherapy regimen.

Upper limb joint mobility ranges during activities of daily living determined by three-dimensional motion analysis--preliminary report.

BACKGROUND: Analysis of hand therapy programmes used in various hand therapy centres shows that the programmes primarily aim to restore a maximum range of motion, although basic activities of daily living do not often require full joint mobility. This report of our investigations, which commenced in 2003, presents the results of an evaluation of the range of motion in the joints of the upper limb, including both proximal and hand joints, during selected daily activities. MATERIAL AND METHOD: Right-handed students of physical therapy were examined using a three-dimensional motion analysis system in the Biokinetics Laboratory of the Division of Biomechanics at the University of Physical Education in Kraków. Spatial registration of movement focused on three daily activities that primarily involve the upper limb, namely, natural movements associated with combing, closing a zip fastener and answering a telephone call. Angular changes in the joints recorded in three movement planes were used as analysis inputs. RESULTS: The range of motion in the analysed joints during daily activities never reached the respective maximal values, usually centering around the middle point of the ranges. CONCLUSIONS: Daily activities require only limited mobility in the upper limb joints. Three-dimensional motion analysis is a useful tool to monitor and assess this phenomenon. The results of such assessments should be taken into account by hand therapists designing and implementing rehabilitation programmes.

Appropriateness and effectiveness of physiotherapeutic treatment procedure after tendon transfer in patients with irreversible radial nerve injury.

Background. Research conducted by many authors has indicated that if muscles are not re-innervated after radial nerve paralysis, it is necessary to perform a tendon transfer operation. The goal of our study was to evaluate the effectiveness of surgical and hand therapy procedures after tendon transfer in patients with irreversible radial nerve injury, and to verify the therapy program preceding and following surgery. Material and methods. Our research material was collected from eight patients at our Center, in whom tendon transfers had been conducted due to lack of wrist and finger extension functions in the metacarpophalangeal joints (MCP) and the lack of extension function of the interphalangeal thumb joint (IP). The effectiveness of the therapy was estimated on the basis of examination results consisting of measurement of the active range of motion (AROM), force of global handgrip and precise grasps, and hand skills, using the Nine Hole Peg Test. For the purpose of calculating hand functions we applied Swanson's methodology. In addition, our methodology included filling in a special ADL questionnaire by our patients. The survey included a list of daily activities and patient's expectations of the operation outcome, and the therapy as well. Results and Conclusions. The results of our research indicated the appropriateness of surgical transfers followed by physical therapy, and proved the effectiveness of our rehabilitation program.